Monday, January 27, 2020

Definition Of A Long Term Condition Nursing Essay

Definition Of A Long Term Condition Nursing Essay The number of people living in the UK with a long term condition is increasing rapidly. As healthcare provision improves and the availability of healthcare increases, the number of people living longer increases. The proportion of the population aged over 80 years will increase to one in twelve over the next 25 years, and one in four will be over the age of 65 years. (Health Delivery Directorate Improvement and Support Team, 2009) As people get older their health may begin to change and are more likely to suffer from illnesses and chronic conditions. At present, care for people with long term conditions, particularly older people, is reactive and interventions generally only take place after an event or exacerbation of a long term illness. A system change by NHS Scotland aims to deliver an integrated, coordinated and preventative health and social care system, especially for people with long term conditions (NHS Scotland, 2007). Definition of a Long Term Condition A long term condition (also called chronic condition) can be defined as health problems that require ongoing care and management over a period of years or decades (WHO, 2012). Long term conditions can sometimes be referred to as chronic diseases. They are conditions that last for a year or longer and can greatly impact on a persons life which may result in the person requiring continued support and care. Long term conditions can affect children as well as adults and is not only the elderly who can be affected. It is also not just confined to physical illness but it can also include a range of mental health illnesses. Amongst the most common long term conditions are diabetes, epilepsy, heart disease, chronic pain, arthritis, some mental health problems, asthma and chronic obstructive pulmonary disease (COPD) (NHS, 2012). Socio-Political Context of Delivery of Care In the past, care for people with long term conditions was generally reactive and unplanned (DHSSPS, 2011). People with long term conditions are twice as likely to be admitted to hospital, and tend to have longer hospital stays. They also account for over 60% of hospital bed days used. Most people who need long term residential care have complex needs from multiple long term conditions (The Scottish Government, 2012). Scotlands approach to the management of long term conditions is based upon the Chronic Care Model developed by Ed Wagner and his colleagues at the MacColl Institute for Healthcare Innovation. This model suggests that if conditions are created to support a partnership that is productive between people who are knowledgeable and are capable of implementing changes and with those who have the long term conditions, then this can be positive steps towards improving the way care is delivered (The Scottish Government, 2009). In the past, care for people with long term conditions was generally reactive and unplanned (DHSSPS, 2011). In 2007, The Scottish Government developed an action plan to better manage care for people with long term conditions. Adopting Wagners Chronic Care model, The Scottish Governments plan was reflected in Better Health, Better Care. The 6 domains of the Chronic Care Model have been mapped to 6 key components of the model for long term conditions care in Scotland:- Multi-professional care teams and their partnership with people with long term conditions Self management of LTCs strategy Gaun Yersel primary care, hospitals, and social work integrating care Integrating evidence-based medicine and clinical guidelines into care and support delivery processes Sharing of Data through supportive information systems Assuring appropriate delivery of care through the national performance framework, HEAT targets and the Community Care Outcomes Framework How the care is delivered In order to deliver a proactive and coordinated care management approach for people with complex and changing needs, health and social care professionals require a range of competencies and skills. Health professionals that work together to deliver this anticipatory care are community nurses, community psychiatric nurses, social workers and care managers (HDDIST, 2009). Anticipatory and Advance care planning (ACP) both adopt a thinking ahead philosophy of care. This allows practitioners and their teams to work with patients and their family members to set and achieve common goals to make sure the right course of treatment has been chosen and is carried out at the right time for the best interests of the patient and their family members or support network (The Scottish Government, 2010). Advance care planning is the term most commonly referred to in end of life care, although it does incorporate the writing of wills or Living Wills now known as advance directives or advance decisions which can be done by the well person early on in life to plan for what may happen at the end of life. Anticipatory care planning is more commonly applied to support those living with a long term condition to plan for an expected change in health or social status. It also incorporates health improvement and staying well. Completion of a common document called an anticipat ory care plan is suggested for both long term conditions and in palliative care (The Scottish Government, 2010). Anticipatory care, as an approach, was pioneered in the 1960s by Van den Dool in The Netherlands and Julian Tudor Hart in Wales. Both approaches involved identifying patients who were at high risk of specific diseases or conditions. This was achieved by reviewing patient medical records when the opportunity arose during routine consultation or when the patient made contact with their medical practice (ODonnell et al, 2012). As an individuals condition appears to be more complex it may be useful to discuss legal and practical issues, as well as individual care and support preferences. As the needs and dependency of an individual increase, it may become appropriate to discuss end of life preferences (Scottish Government, 2009). The Anticipatory Care Plan may then include information about the persons: concerns and personal goals the persons own understanding of their illness and how it will progress a persons own wishes for end of life care, including preference of where care is carried out, as well as their views about the level of interventions, treatments and whether CPR is wanted (Scottish Government, 2009). Government Programmes The Scottish Government (2010) has outlined its commitment to developing a health service that tackles inequalities in health, addressing both health and social determinants, and to delivering a health service that moves away from a reactive, episodic model of care, where the patient is a passive recipient, to a system that anticipates health needs before they arise and that delivers continuous, integrated, preventive care with the patient as partner. Such a model of care has been termed anticipatory care (ODonnell et al, 2012). Recently, the Scottish Government has established Keep Well, a national programme of anticipatory care targeting deprived populations at risk of developing cardiovascular disease (CVD), which brings together a number of the active ingredients important to anticipatory care (ODonnell et al, 2012). NHS Health Scotland provides the national programme management role for Keep Well. Established before the implementation of this government programme, The National Coronary Heart Disease Demonstration Project, Have a Heart Paisley, was a Scottish Government-funded national health demonstration project (2001-2008) hosted by NHS Greater Glasgow and Clyde. It was a partnership between the local community, primary and secondary care and the local authority (NHS Health Scotland, 2012). The initial project was established to reduce heart disease and promote healthier, longer lives for the people of Paisley. It was one of four projects outlined in the Governments White paper Towards a Healthier Sco tland. Have a Heart Paisley moved into its second phase in 2005 2008 which narrowed its focus and allowed an opportunity to build upon phase one. An anticipatory care report published in 2007 by Sridharan et al, outlined challenges for interventions such as Keep Well that are based on the vision described in Delivering for Health such as Identifying individuals within the different levels of disadvantage. Instead of a broad approach to identify a deprived area, a more focused approach may be required to help identify poor people in those deprived areas. The problem is that individuals with the greatest need (e.g. multiple disadvantaged populations with co morbid conditions) may be overlooked and the standard sampling frame such as a Central Data Repository (CDR) may not harness or identify populations with multiple disadvantages (Sridharan et al, 2007). The Long Term Conditions Collaborative (LTCC), aims to support patients to develop person centred care that is effective, safe, timely and reliable, makes best use of the skills of the multi-professional team, and is supported by good communication and sharing of information across teams and care settings (The Scottish Government, 2010). Models of Care The Kaiser Permanente pyramid is a chronic care model which was developed by the Kaiser Permanente Health Institute in the United States. This chronic care model is not a fixed model and people can move up and down the levels as their condition, ability to cope and their general sense of well-being changes (The Scottish Government, 2009). Kaiser Permanente focuses on integrating organisations and disciplines. People with long term conditions are organised and managed according to need, with intensive management targeted at those at highest risk (NHS, 2006). Supporting Literature Research carried out by Baker et al (2012) aimed to identify a population who were at risk of admission to hospital and to provide an anticipatory care plan (ACP) for them. Baker et al (2012) aimed to determine whether, using primary and secondary care data to identify this population and then applying an ACP, can help to reduce hospital admission rates. The results of Baker et al (2012) study showed that whilst not significant, having an ACP and a co-ordinated team based approach can reduce admission rates and reduce hospital bed days. Baker et al (2012) found that a reduction in admission rates is mediated by an increase in transfers out from secondary hospitals to the community hospital and home. Several factors enabled this to happen: improved community support from families and carers who had a better understanding of the course of a disease, care workers who were able to prevent admissions and provide rapid support on discharge, as well as a coordinated approach and good liaiso n between the case manager, local nursing, and the practice (Baker et al, 2012). Cleland, Moffat Small (2012) carried out research to explore stakeholder views of the utility and design of a community-based anticipatory care service (CBACS) for COPD. The key benefits of this service were seen to be reducing hospitalisation, educating patients in self-management in order to improve self-care and reduce acute admissions, and coordination of health and social care (Cleland et al, 2012). ZuWallack Nici, (2010), wrote an article describing the problems associated with the current care delivery approach for people with COPD. ZuWallack Nici (2010) proposed a Chronic Care model for the primary care of people with long term illnesses such as COPD. This model had many similarities to the care approach set out in Better Health, Better Care, with 6 similar components. ZuWallack Nici (2010) found that the integrated care approach is ideally suited to the management of chronic diseases, such as COPD. They claimed that Integrated care is patient centred but not limited to the traditional boundaries of the disease and is not overwhelmed by the complexities of the multi-morbid patient. ZuWallack Nici (2010) claims that there is great emphasis on self management strategies and the co-ordination of care, all of which increase the lines of communication amongst the agencies involved in the care being delivered. Role of the Case Manager The evolving role of case manager in delivering anticipatory care to patients with long term conditions is key to ensuring that care and services for the individual are co-ordinated and do not become fragmented, confusing and overwhelming. It is an opportunity to make best use of the advanced level of knowledge, skills and competencies that District Nurses have developed (HDDIST, 2009). Good communication, co-ordination and information sharing within and between multi-disciplinary teams are essential to ensure that where a person moves between different care settings, for example between primary care and specialist services provided in secondary care, these transitions are seamless and co-ordinated (DHSSPSNI, 2012). IN 2009, Information Services Division (ISD) developed The SPARRA tool. It identifies people who have entered a cycle of repeat admissions to hospital in the previous 3 years and predicts their risk of future hospitalisation. The information on the SPARRA lists supports the patients local team to provide the proactive, planned and co-ordinated care required for people with complex or frequently changing needs. Instead of reactive or crisis care, people and their carers will receive an improved service through a more robust assessment and care planning approach. Delivering continuous, supportive care with a single point of co-ordination improves the experience for the person and their carer; supports care at home and may prevent avoidable hospital admissions (ISD, 2009). SPARRA is only one way of identifying people at high risk of admissions. People who may benefit from care management can be identified by sharing local intelligence at Practice and locality team meetings and by using other community risk prediction tools (ISD, 2009). End of Life Care Palliative care has been described as the active total care of patients whose disease is not responsive to curative treatment. Problems can be encountered with the availability of medicines during the out-of-hours period. To maintain effective symptom control it is important that sufficient quantities of appropriate palliative care drugs, including CDs, are available to anticipate deterioration in the patients condition (NHS Scotland, 2012). Just in case boxes support anticipatory prescribing and access to palliative care medication for patients at the end of life. Adequate quantities of the appropriate medicines (including Controlled Drugs) are prescribed for the patient and stored in an identifiable container the just in case box in the patients home or care home. This is intended to prevent unnecessary delays in symptom management especially out of hours and at weekends (NHS Scotland, 2012). The GP will assess the individual needs of the patient and will issue a prescription for the appropriate medication If symptoms develop the nurse can administer the appropriate drugs without having the delay of contacting the GP to prescribe them (NHS Scotland, 2012). Making appropriate plans to meet a persons changing needs and aid timely transitions to end of life care are critical components of the quality improvement process in health and social care (NHS, 2011). Care planning harnesses the care of people with and without capacity to make their own decisions. The assessment undertaken is person centred and it aims to establish the persons needs, preferences and personal goals relating to their own care and the decisions made to meet these goals with the available resources (NHS, 2011). It can be oriented towards meeting immediate needs, as well as predicting future needs and making appropriate arrangements or contingency plans to address these (NHS, 2011). Where a person lacks capacity to decide, care planning must focus on determining their best interests. This can be achieved through discussions with the persons family or close friends or carers and any decisions made must act to protect the persons best interests (NHS, 2011). Advance care planning (ACP) is a process of discussions with an individual and their care provider to determine the persons wishes should their illness deteriorate in the future. ACPs can lead to an advance statement, an Advance Decision to Refuse Treatment (ADRT), a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision or other types of decision, such as appointing a Lasting Power of Attorney (NHS, 2011). In conclusion, planning should be tailored to individuals a one size fits all approach will not work (NHS, 2011). Individuals have the right to live well with their conditions that are managed holistically and within the boundaries of their own personal needs and desires. Everyone involved with the care planning for an individual should be available for opportunities for follow-on conversations and support. Discussing potential risks and benefits associated with different treatment options will help people make choices and have confidence in agreed treatment and care plans (NHS, 2011). Wordcount: 2743 .

Sunday, January 19, 2020

Network installation

Choosing a network that does not meet an organization's needs leads directly to trouble. A common problem arises from choosing a peer-to-peer network when the situation calls for a server-based network Peer to peer networks share responsibility for processing data among all of the connected devices. Peer-to-peer networking (also known simply as peer networking) differs from client-server networking in several respects. According to the computer specifications a peer-to-peer network is inadequate. It can exhibit problems with changes in the network site. These are more likely to be logistical or operational problems than hardware or software problems. For example users may turn off computers that are providing resources to others on the network. (Rutter, 2008). When a network's design is too limited, it cannot perform satisfactorily in some environments. Problems can vary depending on the type of network topology in effect. The physical topology of a network is the layout or actual appearance of the cabling scheme used on a network. Multipoint topologies share a common channel; each device needs a way to identify itself and the device to which it wants to send information. The method used to identify senders and receivers is called addressing. (Mitchel, 2008) The term topology, or more specifically, network topology, refers to the arrangement or physical layout of computers, cables, and other components on the network. â€Å"Topology† is the standard term that most network professionals use when they refer to the network's basic design. In addition to the term â€Å"topology,† there are other terms that are used to define a network's design: Physical layout, Design, Diagram or Map. (Mitchel, 2008). A network's topology affects its capabilities. The choice of one topology over another will have an impact on the type of equipment the network needs, Capabilities of the equipment, Growth of the network and Way the network is managed. According to Rutter, a network topology needs planning. For example, a particular topology can determine not only the type of cable used but also how the cabling runs through floors, ceilings, and walls. Topology can also determine how computers communicate on the network. Different topologies require different communication methods, and these methods have a great influence on the network. The most popular and recommendable method of connecting the cabling in the proposed computer network is the client server architecture of star topology. Here each device connects to a central point via a point-to-point link. Several names are used for the central point including the following: Hub, Multipoint Repeater, Concentrator, or Multi-Access Unit (MAU). (Microsoft MVP, 2004). For the recommended network, the central point ought to be an intelligent hub, which can make informed path selections and perform some network management. Intelligent hubs route traffic only to the branch of the star on which the receiving node is located. If redundant paths exist, an intelligent hub can route information around normally used paths when cable problems occur. Routers, bridges, ; switches are examples of hub devices that can route transmissions intelligently. These hubs are advanced such that they are able to accommodate several different types of cables. In this case there can be a main hub (the hybrid) with other sub-hubs especially for growth purposes. Intelligent hubs also can incorporate diagnostic features that make it easier to troubleshoot network problems. Hub-based systems are versatile and offer several advantages over systems that do not use hubs. In the standard star topology with hubs, a break in any of the cables attached to the hub affects only a limited segment of the network mostly only one workstation while the rest of the network keeps functioning.   In this kind of a system, wiring systems can be changed or expanded as needed, different ports can be used to accommodate a variety of cabling types and monitoring of network activity and traffic can be centralized. (Rutter, 2008) The star topology has many benefits; first each device is isolated on its own cable. This makes it easy to isolate individual devices from the network by disconnecting them from the wiring hub. Secondly all data goes through the central point, which can be equipped with diagnostic devices that make it easy to trouble shoot and manage the network. Lastly the Hierarchical organization allows isolation of traffic on the channel. This is beneficial when several, but not all, computers place a heavy load on the network. Traffic from those heavily used computers can be separated from the rest or dispersed throughout for a more even flow of traffic. According to Rutter This topology originated in the early days of computing when computers were connected to a centralized mainframe computer. One machine can act as a server and as a client at the same time since the setup is not concerned with security. This machine should be the one with the highest processing speed (3GHz), largest Random Access memory (1 Gb) and enough disk space (120 Gb). The importance of the server is to concentrate common peripheral devices, which do not need to be in multiples in the network. This computer can meet the processing and storage needs of other users, it can be able to support many more users in cases of expansion, it also enables administration of resources centrally in cases of troubleshooting there is more consistency and reliability and it also provides backup for the other machines. The server has many dedicated specialized functions in addition to providing basic network services. First it can be dedicated to managing network printers and print jobs to avoid unnecessary spooling. Secondly it can manage modems and other types of communication links. It can also be used to store large databases and run some database applications. Fourthly it can run an application for the access across the network. It can act as a mail server and provide access to email services as well as sending and forwarding email messages to intended recipients in the network. Lastly a server may provide a wide range of information to the public Internet or private intranets form the network. Upgrades can be to maintain, troubleshoot, update and fix the other computers remotely. It's way more effective than trying to explain what to do over the phone. Conclusion Topologies remain an important part of network design theory. You can probably build a home or small business network without understanding the difference between a bus design and a star design, but understanding the concepts behind these gives you a deeper understanding of important elements like hubs, broadcasts, and routes Work Cited: Brandley Mitchel, The New York Times Company. (2008). Wireless Networking. . Retrieved May 10, 2008 from: http://compnetworking.about.com/ Microsoft Most Valuable Profession, (2004, 1st December). Hardware and software specifications. http://www.ezlan.net/Installing.html Daniel Rutter, (2008,1st April). Ethernet Networking. Retrieved May 10, 2008 from: http://www.dansdata.com/network.htm

Saturday, January 11, 2020

Am I Bowered

How Quickly did the Catchphrase Catch on? What we were particularly interested in was the speed with which the catchphrase caught on and for this we looked at the ‘Catchphrase' sample of 200 participants. For the first 3 weeks people were seeing and hearing Bomb Chicks Way Way through paid for media but by week 4 they suddenly started using it themselves (Figure 5). 6 Figure 5: Week 4 the catchphrase took off The sample sizes were low so need to be treated with caution, but there was a clear shift in week 4.Our tracking period only lasted 8 weeks in total, with two of those before the campaign started, so we were not able to see how usage developed, but at Being used? As well as using the catchphrase while seeing the ads on TV and Posters, we also saw it being used in social networks (although this was picked up under Online rather than Conversation) (Figure 6). Figure 6: In social networks Who was Using it? Perhaps not surprisingly usage of the catchphrase was most positive wh en the participant used it himself.They were clearly very funny! However, it was also positive when girls used it and we did see our participants receiving texts from girls hey liked. Not surprisingly, although we hadn't thought about this until we saw the results of the study, hearing the catchphrase was least positive when another boy used it. When we looked at the comments this was often because little brothers would annoy their older siblings with it (Figure 7)! Figure 7: Positivist by different groups In this sense it could be said that girls were more influential than boys, because our male target audience felt more positive about their usage of the catchphrase than they did when other boys used it. But if some of the experiences were negative, how Eng would it take for the catchphrase to become annoying? What about Whereat? Each time we saw a new TV execution launched, the positivist of the texts increased indicating that the campaign needed new executions to keep it fresh (F igure 8).Figure 8: Positivist highest in first week of new execution When we looked at the Catchphrase stream and saw how negatively people were reacting to the catchphrase ‘Am I Powered', used in the comedy series on TV by Catherine Tate, we could see that catchphrases could wear out relatively quickly (Figure 9). 8 Figure 9: Risk of whereat In fact, ‘Am I Powered' got a bit of a boost when Tony Blair used it during Comic Relief, so this new context refreshed its perception slightly.The learning from ‘Am I Powered' was that Bomb Chicks Way Way should be allowed to burn brightly for a few weeks or months, but certainly wasn't a year long campaign. In hindsight, the switch from Bomb Chicks Way Way to the next Axe campaign was probably slightly too soon, as the brand didn't fully capitalism on the early momentum we saw the catchphrase gathering. For instance, we saw in the main message that young guys were starting to play with the catchphrase and make it their own. If we had continued to monitor the campaign in real time we would have seen the moment when it started to wear out.However, with frequent refreshment of executions, it appeared from our study that it could go on a few months. Recommendations This new real-time research approach helped us to make some clear recommendations. Firstly, the combination of TV and Posters were working well as the Posters were reminding people of the TV ads and were prompting use of the catchphrase. Secondly, it was necessary to keep rolling out new creative executions to keep the campaign fresh. Thirdly, the campaign would wear out if kept going too long but could build momentum over a few months.Finally, the activation was working less strongly because it wasn't linked to the Bomb Chicks Way Way campaign. As a result, online was under-utilized and represented an opportunity for rolling out to other countries. Following these results, Milliner asked us to conduct a thorough evaluation of competitive online touchiness to ensure best practice for future campaigns. Results The combination of a reluctance product and successful advertising campaign, featuring a catchphrase, ensured that Lynx/Axe was able to meet its objectives of sustaining a price increase while growing sales.

Friday, January 3, 2020

Sociology Deviance, Conflict, And Symbolic...

Sociologists define deviance as a behavior, trait, or belief that departs from a norm and generates a negative reaction in a particular group (153). Deviance can be anything. A certain sociably acceptable act in one culture can be seen as deviant in another culture it does not matter how large or small the act. Sociologist developed three theories to help explain deviance. Sociologists explored the functionalism, conflict, and symbolic interactionism approaches to deviance. Emile Durkheim studied deviance with the functionalism approach. Functionalism argues that each element of social structure helps maintain the stability of society (156). Durkheim actually viewed crime and delinquent behavior as a normal and necessary occurrence in a social system. These societies see the behavior as wrong and a punishment is the consequence. Functionalists believe that deviance helps clarify moral boundaries. It helps society’s moral compass to distinguish the difference between what is ri ght and what is wrong. A function of deviance is to promote social cohesion; people can be brought together as a community in the face of crime or other violations (156). A tragedy is known to bring a community together. A great example of how a society comes together in the face of a violation of its rights is 9/11 and the impact it had on society. Most people remember where he or she was and what he or she was doing at the time. During this period of a country mourning, the military saw a surge inShow MoreRelatedThe Theory, Symbolic Interactionism, And Conflict Theory1040 Words   |  5 Pages Faith Williams Dr. Whitman Sociology Abstract This review connects three theoretical frameworks. The first theoretical framework is the symbolic interactionism. 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